The term varicocele refers to the enlargement and dilatation of a group of veins in the scrotum. The pampiniform plexus (this is the name of the group of veins) that dilates with varicocele has the function of drawing venous blood away from the tissues of the testicles

Under normal conditions, these veins have a diameter of approximately 0.5-1.5 centimetres; in varicocele they reach a diameter of more than 2 centimetres.

Two forms of varicocele are usually distinguished:

• the idiopathic varicocele
• the secondary varicocele.

Idiopathic varicocele

Idiopathic varicocele is caused by the malfunction of certain valves in the blood vessel that regulate the flow of blood within the vein itself.

It is, essentially, the same mechanism that gives rise to varicose veins on the legs: the malfunction of these valves causes blood to flow into the blood vessel in the opposite direction, causing an increase in pressure that damages the tissues of the walls.

Varicocele can occur on both sides of the scrotum or only on one side, usually the left.

This is because, while venous blood from the right side of the scrotum enters the vena cava at groin level, that from the left side enters the renal artery, located higher up.

The malfunctioning of the valves of the veins thus causes increased pressure on the tissues.

Secondary varicocele

The alteration of normal blood flow in secondary varicocele originates, on the other hand, in the presence of external compression on the veins.

This is the case, for example, with a pelvic or abdominal tumour.

Varicocele: a few notes on anatomy

The testicles are supplied with blood by the testicular artery through the inguinal canal which connects the scrotum with the abdomen.

The testicular veins, after collecting the veins of the epididymis, ascend to form part of the spermatic funiculus, which constitutes the pampiniform plexus: it is from the latter that the testicular vein originates, which on the left side flows into the ipsilateral renal vein and on the right into the inferior vena cava.

These veins in men, very rarely in women, may dilate as a result of incontinence of the veins, preventing the outflow of blood from the testicle to the upper part of the body, thus resulting in reflux and stasis of blood in the testicle.

Varicocele and fertility

Varicocele is a very common disorder that occurs in 10 – 15% of men, 10% of boys between the ages of 10 and 22, and 35 – 40% of men with fertility problems.

In 95% of cases it occurs on the left testicle, very rarely on the right, but it can also occur bilaterally.

Locally, blood pressure in the dilated veins, stasis, can cause pain and psychologically inhibit the sexual sphere with an erection deficit.

On the other hand, this pathology, which can present in varying degrees (from 1st to 4th in ascending order of importance), can deteriorate and change spermatozoa in terms of shape, motility and number, causing possible future fertility problems.

In fact, increased pressure in the veins causes an oxidative alteration, a state of hypoxia and a drop in testosterone.

Once a diagnosis has been made, it is always recommended that the patient perform a spermiogram that will show the state of the seminal fluid.

Symptoms of varicocele

Varicocele does not generally present painful symptoms.

Many times, in fact, a diagnosis is made on the basis of routine checks.

How to recognise it?

A sense of heaviness is felt at scrotal level, most often more to the left.

Testicular discomfort, most often on the left side, after prolonged sexual intercourse, after standing for a long time, after physical exertion (football/running/tennis/cycling);

Deaf scrotal pain

At the specialist urological examination, one can appreciate the dilated and palpable veins at scrotal level as a “small bag of worms” and appreciate the degree of importance of the varicocele.

The diagnosis of varicocele is based on

• a specialist urological examination with local objectivity;
• performance of Eco-colour Doppler of the spermatic vessels, which will show the degree of the varicocele;
• performance of Doppler flowmetry;
• spermiogram.

Treatment of varicocele

If the spermiogram proves to be altered, the degree of the varicocele and the patient’s age will be assessed, but most of the time surgery will be recommended, which may be

• open (according to Palomo or Ivannisevich) with ligation and sectioning of the spermatic vein;
• sclerotization of the spermatic vein;
• embolisation of the spermatic vein.

Recovery from the operation is generally rapid: post-operative pain is scarce and post-operative swelling is reduced by an ice bag, kept on the area for the first 24 hours.

A couple of days are sufficient for a return to normal daily activities, while activities involving exertion may take a couple of weeks.

The return to full sexual fertility takes longer: 4 to 5 months after the above-mentioned surgeries are performed, the seminal fluid shows an improvement of around 30/45%.

Spermyogram with varicocele

The results of the spermiogram in a subject with a varicocele may indicate several conditions.

Here is how to interpret the tests:

• Normozoospermia: normal result, according to reference values
• Asthenozoospermia: altered sperm motility
• Oligozoospermia: reduced sperm count
• Cryptoospermia: severe spermatozoa deficiency
• Azoospermia: absence of spermatozoa in the seminal fluid
• Teratozoospermia: altered morphology of spermatozoa
• Oligoasthenoteratozoospermia: alterations in all variables.

Read Also:

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Varicocele: What Is It And What Are The Symptoms?

Male Pathologies: What Is Varicocele And How To Treat It

Pelvic Varicocele: What It Is And How To Recognise The Symptoms

What Is Varicocele And How Is It Treated?

Source:

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